What can be learned from natural disasters, from the healthcare IT standpoint? As it turns out, a lot can. At a session held on Wednesday during HIMSS18, held this week at the Sands Convention Center in Las Vegas, healthcare IT leaders from different communities shared their perspectives on some of what happened during and after Hurricanes Irma, Maria, and Harvey last year.
As the session description of Session 64, “Learning from the Devastating Effects of Three Hurricanes: The Critical Role of Health IT,” summarized it, “During the 2017 hurricane season, Mother Nature launched an all-out assault on portions of Texas, Florida, Puerto Rico and the Virgin Islands. With harsh winds, heavy rain resulting in historic flooding, and the aftermath that affected every aspect of human existence, there are lessons for all to learn regardless of the type of natural disaster. From a health IT perspective, many prepare for a potential disaster across infrastructure, communications, and alternatives to patient care delivery that organizations hope never occur. However, in the case of Hurricanes Harvey, Irma, and Maria, it affected every aspect of healthcare operations.”
José L. Abrams Guzmán, CIO and CTO at Servicios de Salud Episcopales, a health system based in Ponce, and anchored by Hospital San Lucas Ponce, a 161-bed community hospital, shared with the audience the devastating experience of Hurricane Maria, which hit Puerto Rico in September, just days after Hurricane Irma had hit the island. “We have 3.4 million people in Puerto Rico,” he noted. “Being an island presents a lot of challenges, because of the distance, and also around health services.”
What’s more, Abrams Guzmán noted, “We had activated our contingency plans” when Maria hit. “The problem is that we probably think that the worst that is going to happen is being cut off for a two-week period”; and in fact, as everyone now knows, the effects of Hurricane Maria have lasted even through the present. Among the issues related to that: “an old and susceptible power infrastructure with a median age of power plants equal to 44 years. Still recovering from Irma, two weeks earlier, about 80,000 people remained without power while Maria approached,” Abrams Guzmán noted. “Yes, 450 shelters opened on the afternoon of September 8,” he recounted. “By September 19, at least 2,000 people in Puerto Rico had sought refuge.”
Among the key operational challenges: “There was no information during or immediately after the emergency, and only one AM radio station was on the air. No communication between and among clinicians, administration personnel, service providers, suppliers, police stations, and emergency responders, was possible.” Meanwhile, “Airports and marine ports were paralyzed. And, as healthcare services, we weren’t the priority for emergency responders.” What’s more, he noted, “Everything had to be paid for in cash.”
What was learned from the experience of Hurricane Maria? In fact, Abrams Guzmán told the audience, “We learned a lot of things. First, we need to be prepared for a completely isolated situation, and consider the worst-case scenario, that of a power and communications loss of 100 percent.” Prior to Maria, he said, “we had usually prepared to manage a two-week period of an emergency.” That no longer appears realistic going into the future.
What’s more, Abrams Guzmán said, “During the recovery process, both electricity and communications may fail intermittently. Indeed,” he said, “we’re still having problems with power and communications.” What’s more, “After the emergency, we need the ability to install an alternate regional communications system. If you don’t have communications to transfer patients from one location to another, how can you manage that?”
Among the actions that should be considered in the future, Abrams Guzmán said, are these: “A regional repository of patient data should be considered for cases where access to the EHR [electronic health record] is lost. What about all the data?” Also, “We have processes to manage the situation on paper, but what about the data of the patient? We should establish regional centers to maintain data.” In addition, he said, “We need to maintain good relationships with service providers, which is the only way to ensure you’re one of their priorities.” Further, he said, “You need 3X redundancy in power. We had 3X redundancy in power at our hospital, which is better than 2X. That’s better both in power generators and communications.”
In addition, he said, “During emergencies, improvisation is allowed. Technology allows us to redesign during the recovery process.” And, he said, “the choice of cloud versus onsite data centers, must be evaluated.”